Is Boyd's Operation a Last Solution that May Prevent Major Amputations in Diabetic Foot Patients?

• Published in: The Journal of foot and ankle surgery 2008-07, Vol.47 (4), p.307-312
• Main Authors: Altindas, Muzaffer, MD, Kilic, Ali, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Amputation; Associated diseases and complications; Biological and medical sciences; Boyd's operation; Diabetes. Impaired glucose tolerance; diabetic foot; Diabetic Foot - complications; Diabetic Foot - surgery; Diseases of the osteoarticular system; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Orthopedic Procedures - methods; Orthopedic surgery; Orthopedics; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; ulcer; wound
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2008.02.019

We had several difficulties in dealing with diabetic foot lesions and infections at the level of midfoot and hindfoot. At this level of the foot, bone and joint involvement is quite common. We had to perform major amputations in most of these patients. As our search to overcome this problem continued, we concluded that the relationship between infection, necrosis, and hypo-avascular tissue is very strong in this part of the foot. At the end, we have seen that Boyd's operation can break this vicious cycle. Boyd's operation consists of talectomy, excision of articular surfaces of tibia and calcaneus, and tibiocalcaneal arthrodesis. It can be performed as single or 2-staged operation depending on clinical judgment. After the first stage of operation, the defect is left open for a period. With local wound care, the defect is prepared for definitive closure and closed secondarily. We have performed Boyd's operation in 16 patients with diabetic foot lesions and infections reaching midfoot and hindfoot regions. In 15 patients, complete healing was achieved and these patients were able to walk themselves. Mean follow-up period was 3.2 years. Most of the time the heel region and calcaneus are not on the pathways of severe foot infections. Therefore, the most important criterion that is necessary to perform Boyd's operation usually do exist. After the Boyd's operation, an optimal condition for wound healing is achieved by removing all bradytrophic (hypovascular) tissues in the foot. Boyd's operation is superior to other partial midfoot and hindfoot amputations in terms of anatomy and function. Level of Clinical Evidence: 4.